<%--
  Created by IntelliJ IDEA.
  User: ZOUTONG
  Date: 2021/5/25
  医生修改处方笺
  Time: 10:23
  To change this template use File | Settings | File Templates.
--%>
<%@ page contentType="text/html;charset=UTF-8" language="java" %>
<html>
<head>
    <title>Title</title>
</head>
<body>

<div class="bj" ></div>
<div class="recipe">
    <p class="no" style="float: right; width: 30px; font-size:30px">×&nbsp;</p>
    <h1 style="margin: 16px auto; width: 400px;text-align: center">湖南省长沙市华子医院处方笺</h1>

    <form class="layui-form" action="" id="updatetye">
        <div class="layui-form-item">
            <label class="layui-form-label">诊断号：</label>
            <div class="layui-input-block">
                <input type="text" name="id" readonly  lay-verify="title" autocomplete="off" placeholder="请输入标题" class="layui-input">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">姓名：</label>
            <div class="layui-input-block">
                <input type="text" name="username" readonly lay-verify="required" lay-reqtext="用户名是必填项，岂能为空？" placeholder="请输入" autocomplete="off" class="layui-input">
            </div>
        </div>


        <div class="layui-form-item">

            <div class="layui-inline">
                <label class="layui-form-label"></label>

                <div class="layui-input-inline">

                    <input type="tel" name="drug" lay-verify="" readonly autocomplete="off" class="layui-input" style="display: none" value="13974050958">
                </div>
            </div>
            <div class="layui-inline">
                <label class="layui-form-label">验证日期：</label>
                <div class="layui-input-inline">
                    <input type="text" name="date" id="date" lay-verify="" placeholder="yyyy-MM-dd" autocomplete="off" class="layui-input">
                </div>
            </div>
        </div>

        <div class="layui-form-item">


            <div class="layui-inline">
                <label class="layui-form-label">数量：</label>
                <div class="layui-input-inline">
                    <input type="text" name="data" class="layui-input" >
                </div>
            </div>
            <div class="layui-inline">
                <label class="layui-form-label">医生：</label>
                <div class="layui-input-inline">
                    <input type="tel" name="doctorname" readonly lay-verify="" autocomplete="off" class="layui-input">
                </div>
            </div>
        </div>


        <div class="layui-form-item layui-form-text">
            <label class="layui-form-label">医嘱：</label>
            <div class="layui-input-block">
                <textarea placeholder="请输入内容" class="layui-textarea"></textarea>
            </div>
        </div>
        <!--<div class="layui-form-item layui-form-text">
          <label class="layui-form-label">编辑器</label>
          <div class="layui-input-block">
            <textarea class="layui-textarea layui-hide" name="content" lay-verify="content" id="LAY_demo_editor"></textarea>
          </div>
        </div>-->
        <div class="layui-form-item">
            <div class="layui-input-block" style="margin-left:400px;">
                <button type="button"  id="update" class="layui-btn" lay-submit="" lay-filter="demo1">确定</button>
                <button type="reset" class="layui-btn layui-btn-primary">重置</button>
                <button type="no" class="layui-btn layui-btn-primary" class="no">取消</button>
            </div>
        </div>

        <div class="drug">
            <label class="layui-form-label">搜索选择框</label>
            <div class="layui-input-inline">
                <select name="modules" lay-verify="required" lay-search="" id="xiala">
                    <c:forEach items="${requestScope.list}" var="list">
                        <option value="${list.id}">${list.drugname}</option>
                    </c:forEach>
                </select>
            </div>
        </div>



    </form>





</div>

</body>
</html>
